Basal Cell Carcinoma (Skin Cancer) Symptoms, Causes, Treatment

Basal cell carcinoma (BCC) is the most common form of skin cancer globally. At one time it was among the most common cancers in South Africa, largely associated with the sunny climate and high UV radiation exposure. With greater awareness about skin cancer these days, basal cell carcinoma is often detected and treated early. Regular skin examinations and sun protection are crucial in preventing basal cell carcinoma and ensuring healthy skin for years to come.

What is basal cell carcinoma?

Basal cell carcinoma (BCC) is a type of skin cancer that arises from the basal cells, which are located in the outermost layer of the skin (epidermis). These cells are responsible for producing new skin cells. Basal cell carcinoma occurs when there is abnormal and uncontrolled growth of these cells, often appearing in areas of the skin frequently exposed to the sun, such as the face, neck, and hands. Although it rarely spreads to other parts of the body, basal cell carcinoma can cause significant damage to surrounding tissues if left untreated.

Causes of Basal Cell Carcinoma

The primary cause of basal cell carcinoma is DNA damage in basal cells, usually due to ultraviolet (UV) radiation. Contributing factors include:

• Chronic Sun Exposure : Prolonged and cumulative exposure to UV rays from the sun or tanning beds.
• Lighter Complexion : Individuals with lighter skin, hair, and eye color are at higher risk.
• Genetic Predisposition : Family history of skin cancer increases susceptibility.
• Weakened Immune System : Conditions such as HIV/AIDS or immunosuppressive medications post-transplant can elevate risk.
• Exposure to Carcinogens : Contact with substances like arsenic may contribute.
• Radiation Therapy : Prior radiation treatments can predispose individuals to basal cell carcinoma in treated areas.

Signs and Symptoms

Basal cell carcinoma often develops slowly, and its symptoms may vary depending on the type. It is important that any skin lesion that is suspicious, especially if it is growing in size, is examined by a medical professional. Common signs and symptoms include:

• Open Sores : Persistent, non-healing sores that bleed, ooze, or crust.
• Pearly Bumps : Flesh-colored, white, or pink bumps with a pearly or waxy appearance.
• Flat Lesions : Scaly, reddish patches that may appear on sun-exposed areas.
• Growths with Rolled Edges : Elevated lesions with a central indentation and visible blood vessels.
• Scar-Like Areas : Waxy, white, or yellow areas resembling a scar.

Diagnosis of Basal Cell Carcinoma

Accurate diagnosis is essential for effective treatment. This needs to be done by a medical professional. Do not attempt to self-diagnose as it can delay early treatment. Diagnostic steps include:

• Physical Examination : A dermatologist examines the skin for suspicious growths or lesions.
• Dermoscopy : A specialised lens that magnifies the skin’s surface for closer inspection.
• Biopsy : A small tissue sample is taken from the lesion and analyzed under a microscope to confirm the diagnosis.

Treatment of Basal Cell Carcinoma

Basal cell carcinoma treatment aims to remove the cancerous tissue while minimising skin damage for cosmetic reasons.

Surgical Treatments

• Excisional Surgery: The tumor and a margin of healthy tissue are removed.
• Mohs Surgery: Layer-by-layer removal of cancer cells, preserving as much healthy tissue as possible. It is especially useful for facial BCCs.

Non-Surgical Options

• Cryotherapy : Freezing and destroying cancer cells with liquid nitrogen.
• Topical Medications: Creams like imiquimod or fluorouracil for superficial BCCs.
• Radiation Therapy: High-energy beams target and destroy cancer cells, often used for patients unable to undergo surgery.

Targeted Therapy

• Drugs like vismodegib or sonidegib block specific pathways in cancer cells, used for advanced BCC.
• Electrodesiccation and Curettage (ED&C):
• Scraping away cancer cells followed by cauterization.

Prevention of Basal Cell Carcinoma

Preventative measures can significantly reduce the risk of developing basal cell carcinoma.

• Sun Protection:
  – Use sunscreen with SPF 30 or higher.
  – Wear protective clothing, wide-brimmed hats, and sunglasses.
  – Avoid peak UV hours (10 a.m. to 4 p.m.).
  – Minimise time on tanning beds.
• Regular Skin Checks: Conduct self-examinations and schedule regular check-ups with a dermatologist.
• Healthy Lifestyle: Maintain a balanced diet and avoid smoking.